well info - Laserfiche WebLink

Home Browse Search

WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring I„I �7��Q A County Name WELL AND BORING SEALING RECORD M nnleso a�Unique Well No. ' �� Minnesota Statutes,Cha ter 1031 or W-series No. HENNEPIN p "aa°e°1e""""��`"�"", Township Name Township No. Range No. Section No. Fraction(sm.�Ig.) Date Sealed Date Well or Boring Constructed ORONO i 17 23 17 '�NE'�NW� Thursday,July 31,2008 GPS Latitude degrees minutes seconds Depth Before Sealing $� fl. Original Depth�'�� ft. LOCATION: Longitude degrees minutes seconds AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location �y Single Aquifer ❑Multiaquifer 07�1� 1810 SFIf1DYVNOOD R{3/1U,��Q,�9� WELL/BORING �Measured �]Estimated Date Measured �Water-Supply Well ❑Monit.Well Show exact location of well or boring Sketch map of well or boring Env.Bore Hole 47 �y below in section grid with"X" location,showing property ❑ ❑Other ft. ❑above land surface N lines,roads,and buildings. CASING TYPE(S) s � , � � . --'-- -- ---`-- ---'— �: q �Steel ❑Plastic ❑Tile [J Other ��¢�TBiC �Y --�-----�--- ---�-- ---'-- d WELLHEAD COMPLETION �� ' W � � � � E � ' WELI � � � � T � `.z�,r��.. Outside: ❑Well House �]At Grade Inside: ❑Basement Offset �. --�----;--- ---�-- —'%-- I --- , , , , �Mile iteesslA p NUnit �_�Buried �Well Pit O , , , , � ❑P� da te � �� --�---—�--- --�-- --�-- �: y� ❑Buried ' S ' a ❑W IIP't ❑Other �-1 Mile—� m ❑Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) RlCFiRRDSON,CliAD 8 JENNlFER Diameter Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different ihan well location address indicated above 2 in.from 6 to 8� R C Yes �No ❑Yes ❑No ❑UnknOwn 1810 Si-iADYWOOD ROAD �R��,��9� in.from to fl. ❑Yes ❑No ❑Yes ❑No ❑Unknown - _in.from to ft. �Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEWOPEN HOLE Wel�l o�wAnEer's mailing address if diHerent than properry owner's address indicated above SCfeen ffOm_ 87 to R. Open Hole from to ft. $/�E OBSTRUCTIONS ;g,Rods/Drop Pipe ❑Check Valve(s) �]Debris [J Fill �No Obstruction Type of Obstructions(Describe) RE.YRDf7Ld 54'WOOf!ROdS A(1d PkIOgEf � GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? �Ves ��No Describe FORMATION PUMP � , - If not known,indicate estimated formation log from nearby well or boring. $tr0�(e PWif� Type _ GEOLdCY FROM: 17 FAGERN POINT AD Ixl Removed ❑Not Present ❑Other CI3 O 3O METHOD USEDTO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: G�� r�` � � �,No Annular Space Exists U Annular Space Grouted with Tremie Pipe ❑Casing Perforetion/Removal ____ in.from to _ft. ❑Perforated [�Removed Clay 58 102 in.from to ft. ❑Perforated ❑Removed Sand - ht i02 1fl7 �� 7 127 Type of Perforator ____ StatiC Water-35' Ci other GROUTING MATERIAL(S) (One bag of cement=94 Ibs.,one bag of bentonite=50 Ibs.) Grouting Material �t� from s to 6.5 n 0_0$15 � bags �� from 6'S to 81 n 12-�435� bags irom to ft._ � � bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ��Yes �No How many? Weli Located!n Pump Room On West Side Of Basement LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report W��1�SUf�FfW(i�if�e LeY� is true to the best of my knowledge. o«�Edson-state�r�spector was on sae ou�y wea Myron L. Malenke/Ma ke Water n�)4�-� �a2s: ,o Licensee B ness Nam License or Registration No. � fieceived Weli Sealirg Notifiption From M.D.H f � ��' � /�' ,C_ i ,• M.L.Malenke-347_ A Juty 31,2008 �7 ��7 � 2� �7 Certili d Representative ignature Certified Rep.No. Date �oC��rCaY H 2?210 4 - Name of Person Sealing Well or Boring HE-01434-10 IC#140-0423 5/o7R �